None listed
Conditions
Brief summary
This study will assess the effect on swallowing of a well-known voice therapy treatment (Lee Silverman Voice Treatment) for patients with Parkinson's Disease. Those who are having Voice therapy to help improve speech will be invited to have their swallowing assessed before and after the therapy has taken place. We believe the therapy will also improve swallowing, as it does speech, and we intend to measure the improvement by analyzing barium contrast swallow studies performed before and after the therapy is done.
Interventions
Patients receiving Lee Silverman Voice Therapy will be studied with pre-treatment and post-treatment videofluoroscopic swallowing studies to assess effect on swallowing. Exposure is three videofluoroscopic swallowing studies at time 0, one week post therapy and six months post therapy
Lee Silverman Voice Therapy will be conducted as per standardized protocol.
*Criteria for Lee Silverman Voice Therapy
a) Motivated and able to commit to intensive therapy
b) Adequate hearing
c) Adequate cognition
Patients receiving Lee Silverman Voice Therapy will be studied with pre-treatment and post-treatment videofluoroscopic swallowing studies to assess effect on swallowing. Exposure is three videofluoroscopic swallowing studies at time 0, one week post therapy and six months post therapy Lee Silverman Voice Therapy will be conducted as per standardized protocol. *Criteria for Lee Silverman Voice Therapy a) Motivated and able to commit to intensive therapy b) Adequate hearing c) Adequate cognition and memory d) Able to access a community clinic close to their home e) Positive results on stimulability testing suggesting likely response to treatment (is the patient able to improve loudness and quality? Can they achieve sustained vowel phonation, high and low pitch slide on ‘ah’ and functional phrases?) f) Socially active and keen to increase participation g) ORL assessment indicates that there are no contraindications for intensive voice treatment *Measures recorded for Lee Silverman Voice Therapy a) Average dB duration ‘ah’ (sustained phonation) b) Average length of maximum duration ‘ah’ c) Average dB of functional phrases d) Average dB of conversational speech e) Complete Voice Handicap Index pre- and post-therapy Subjects then undergo Lee Silverman Voice Treatment (registered trademark) consisting of 2 assessment sessions and 16 treatment sessions over six weeks (three sessions per week). At each session the subject participates in instructed vocal exercises consisting of prolonged vowel phonation with increasing volumes, functional words and phrases with increasing volumes, measured and modified by a sound meter. Biofeedback is provided during sessions by listening to recorded personal phonation and subjects rate their own voice. Sessions are approximately 45 minutes long. This is a designated treatment regimen for voice problems in Parkinson's Disease. No deviations are permitted. VFS studies are approximately 10-15 minutes in length. LSVT is administered as a single block of treatment. This will occur once over 3 weeks. VFSS will be performed on three occasions ie. pre-therapy, one week post completion of therapy and six months post completion of therapy.
Sponsors
Jacqueline Allen
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Diagnosis
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
1) Parkinson’s Disease patients with voice dysfunction desiring voice therapy and meeting inclusion criteria for Lee Silverman Voice Treatment [registered trademark] (*see below) 2) Ability to attend 18 sessions of therapy and three swallowing assessments (VFSS) 3) Ability to complete self assessment questionnaires (Eating Assessment Tool-10) by oral report or written completion *Criteria for Lee Silverman Voice Therapy a) Motivated and able to commit to intensive therapy b) Adequate hearing c) Adequate cognition and memory d) Able to access a community clinic close to their home e) Positive results on stimulability testing suggesting likely response to treatment (is the patient able to improve loudness and quality? Can they achieve sustained vowel phonation, high and low pitch slide on ‘ah’ and functional phrases?) f) Socially active and keen to increase participation g) ORL assessment indicates that there are no contraindications for intensive voice treatment *Measures recorded for Lee Silverman Voice Therapy a) Average dB duration ‘ah’ (sustained phonation) b) Average length of maximum duration ‘ah’ c) Average dB of functional phrases d) Average dB of conversational speech e) Complete Voice Handicap Index pre- and post-therapy
Exclusion criteria
Exclusion Criteria: 1) Parkinson’s Disease without voice dysfunction 2) Do not meet criteria for Lee Silverman Voice Therapy 3) Inability to attend full course of therapy or follow up reviews and swallow studies 4) Vocal pathology requiring alternative treatment eg. Surgery 5) Previous LSVT training 6) Previous history of head and neck radiotherapy treatment 7) Co morbidity affecting swallowing ability eg. Cerebrovascular accident, neurogenic dysphagia of other aetiology, post-surgical dysphagia, infective dysphagia or dementia 8) Esophageal phase dysphagia as defined as personal history and/or documented diagnosis of esophageal dysmotility, hiatal hernia, stricture, eosinophilic esophagitis, erosive peptic esophagitis, and/or systemic disease affecting the esophagus 9) Currently pregnant, as evidenced by a positive result on a pregnancy test if the patient is within child bearing age (younger than 45 years of age). Unlikely to be any subjects that meet this criteria. 10) Non oral feeding for primary nutrition 11) Active tumour involving the larynx or oesophagus 12) Allergic reaction to barium contrast agent 13) Patients with a current, at the time of evaluation, and/or history of Zenker’s diverticulum. 14) Patients with orocutaneous or pharyngocutaneous fistulae at the time of evaluation. 15) Patients with bilateral vocal fold immobility in any position, as evidenced on endoscopy (will not qualify for LSVT). 16) Patients under palliative care. 17) Presence of a tracheotomy tube or airway obstruction necessitating a tracheotomy tube.
Outcome results
None listed